In addition, there is a decrease in kidney filtration resulting in fluid retention and shortness of breath. If CHF is not optimally treated, a sharp decline in health can occur followed by sudden death. Global treatment of the disease including a proper medication regimen, muitidisciplinary patient education, and regular exercise have been shown to increase functional capacity and quality of life, while decreasing hospital admissions for CHF.
A primary treatment of CHF is through a proper medication regimen. Angiotensin-converting enzyme (ACE) inhibitors is used to treat high blood pressure, the main contributor to heart failure (Meyer, 2001). Previously, CHF patients were instructed to rest and avoid exercise in order to postpone disease progression and to promote diuresis induced by bed rest (Sullivan & Hawthorne, 1996). However, exercise, although not prescribed for heart failure patients until the late 1980s, has produced positive physiological changes. Regular exercise increases the blood flow to the working muscle, reduces ventilation for each given workload, and improves skeletal muscle overall function (biochemical and histological aspects), causing the neurohormonal activity to normalize (catecholemines) (Parnell, Hoist, & Kaye, 2002). These benefits, incurred from exercise, improved quality of life scores among CHF patients (Oka et al, 2000; Weber et al, 2000). Exercise training is also responsible for producing significant increases in systemic arterial compliance in just eight weeks, an important contribution to cardiac afterload (arterial resistance encountered by blood as it leaves the left ventricle of the heart) (Parnell, Hoist, & Kaye, 2002). Furthermore, exercise may reduce the risk of death for CHF patients, just as it does for patients who have coronary artery disease (McKelvie, Teo, & McCartney, 1995). In addition, programs which include a component of aerobic exercise training contribute to improved skeletal muscle functioning, cardiac ejection fraction (EF), ambulatory distance walked, and activities of daily living among patients with CHF (Arahata et al, 2000).
Simultaneously, it has been continuously reported that patients with heart failure are often readmitted to the hospital because they lack the knowledge about managing the disease and show little adherence to exercise and physical activity (Blyth, et al., 1997). This problem prompts the development and implementation of multidisciplinary education approach for CHF and other special population advocating the effectiveness and the necessity of exercise as a part of treatment regimen. This paper aims to discuss and analyze the benefits of physical activity and exercise for CHF population as well as motivational techniques and strategies targeting resisting special population improving their exercise adherence.
2. IMPACT OF EXERCISE FOR CHF POPULATION
A. CARDIOVASCULAR EXERCISE PRESCRIPTION
The cardiovascular exercise prescription for patients with CHF historically has been modeled from fitness training, rehabilitation studies, or another steady state protocol designed for the apparently healthy individual (Meyer, 2001). However, more recent research recommendations have advocated the interval method (exercise followed by a short